This is an article from Hyperparic Medicine Today featuring a conversation David Freels had with Dr. George Hart in 2000. Much of the conversation centers on some of the conditions and treatments that Medicare will not cover, including HBOT.
Featured Article MEDICARE’S NONCOVERED CONDITIONS; A Conversation With Dr. George B. Hart by David Freels Editorʼs Notes The following article recounts a phone conversation between naming names) but he ﬁrst had several loose ends to tie up. Dr. George Hart and David Freels in August of 2000. The I called Dr. Hart back two weeks later to discuss this again phone conversation was intended to be information for David and he told me he had accepted a position back at Long Freels’ legal case and not intended to be an investigational Beach Memorial Hospital and had changed his mind about article on sickle cell anemia or anything else. After David the article and didn’t want to discuss it any further. This was Freels had this amazing conversation he called me to ask so abrupt that I continued over the next few years trying to if I knew anything about Dr. Hart or the “Noncovered” persuade him as a medical professional, as a Naval ofﬁcer, indications. I told Mr. Freels that I knew Dr. Hart but was and as a concerned citizen, to please come forward and not aware how involved he was with the creation of the list. correct this terrible injustice. I spent countless hours on the I told David I was very interested in hearing Dr. Hart’s story phone, sending E-mails, pleading with him to go public with because if there was any truth to it, it would change our ﬁeld his story. and answer the age old question “what is it that is holding hyperbarics back?” I can afﬁrm that through my phone conversations and E- mails that everything David Freels has reported here was I called Dr. Hart in September of 2000 to check Mr. Freels’ also reported to me by Dr. Hart. We are publishing one of the story. I did not tell Dr. Hart that I spoke with David but letters Dr. Hart wrote to David to verify this conversation rather pursued a line of questioning about the Medicare and its original purpose (sickle cell anemia and the other “Noncovered” conditions. Dr. Hart conﬁrmed every thing “Noncovered indications”). David Freels writes here and told me that he had been waiting 30 years for someone to ask him about the “Noncovered” I have appealed to Dr. Hart on every level to please come indications. This article has been three years coming because forward with his story. He has refused, telling me “I will let Mr. Freels and I have both, slowly over time, tried to appeal my peers judge me on my accomplishments.” to Dr. Hart to come forward with the complete details of who told him to suppress these indications or take the position These are the events as relayed from David Freels in a phone he did. My ﬁrst conversation ended with Dr. Hart telling me conversation in August of 2000 from his notes. he would give me a complete account for publication (i.e. My wife and I ﬁrst requested Medicaid 14 “Covered Conditions” of HBOT and 22 studies & references for each “Noncovered reimbursement for our son Jimmy in 1999. “Noncovered Conditions”. According to the Condition AND hyperbaric”. The number Jimmy suffers from mid-brain injury but like Ethics Committee report of the Undersea of references appears in parentheses. I 95% of all brain-injured children, he made and Hyperbaric Medical Society (UHMS), was surprised to learn there was so much tremendous gains with Hyperbaric Oxygen the “Noncovered” list is equivalent to an evidence on HBOT and its efﬁcacy for Therapy. After three denials between May off-label uses list. nearly everything on the “Noncovered” and December, 1999, we requested a hearing It occurred to me that maybe Georgia list. before an Administrative Law Judge (ALJ). Medicaid had already reimbursed Our ﬁrst hearing date was July 6, 2000 and HBOT for one of the other “Noncovered According to Section 35-10B of the scheduled to reconvene in late September, Conditions”, which would set a precedent Medicare Coverage Issues Manual, “No 2000. The whole issue was about accessing and open the door for us to also access off- program payment may be made for HBO in off-label HBOT. A big problem was Georgia label hyperbaric oxygen therapy. the treatment of the following conditions:” Medicaid was following Medicare policy on HBOT reimbursement. Medicare has For this article I did a Medline review of Hyperbaric Medicine Today - 7 Featured Article Hyperbaric Medicine Today - 8 Featured Article 1. Cutaneous, decubitus, and stasis ulcers. 2000, my U.S. Representative was Cynthia Then Dr. Hart said; “Hyperbaric oxygen (176 Medline references) McKinney, always a very outspoken critic also works for sickle cell priapism. 2. Chronic peripheral vascular of the US government and some would say insufﬁciency. (50 Medline references) particularly partisan when it comes to any David Freels: “Whatʼs that?” 3. Anaerobic septicemia and infection and all issues involving African-Americans. other than clostridial. I wanted to present the sickle/HBOT data Dr. Hart: (84 Medline references) to Cynthia McKinney so she would in turn “The penis stays in a perpetually erect state 4. Skin burns (thermal). light a ﬁre under Georgia Medicaid to treat at two or thee times its normal size. It stays (42 Medline references) sickle cell kids with off-label HBOT. that way for weeks and even months at a 5. Senility. (3 Medline references) time. Most of the time they die and nothing 6. Myocardial infarction. (heart attack) Then, once we returned to our hearing we can be done.” (110 Medline references) could point out that Georgia Medicaid was 7. Cardiogenic shock. (heart pumping already treating children with off-label David Freels: “Youʼre kidding.” is inadequate) (15 Medline references) hyperbaric oxygen. First I had to get sickle 8. Sickle cell anemia. (sickle-shaped red documentation, but I had no idea where to Dr. Hart: blood cells block circulation) look. I started with a post on the old HBO “No, itʼs a despicable disease. We treated (16 Medline references) chat room. I received several responses, and a priapism case with 2 atmospheres 9. Acute thermal and chemical pulmonary each one said a Dr. George Hart had done hyperbaric oxygen twice a day in a damage, i.e., smoke inhalation with some research on sickle cell and hyperbaric monoplace chamber. It was completely pulmonary insufﬁciency. oxygen. resolved in 2 weeks and the patient had (77 Medline references) been hospitalized for over 9 months for 10. Acute or chronic cerebral vascular Members of the chat room said that Dr. this. Theyʼd given the patient I donʼt know insufﬁciency. (118 Medline references) Hart was at Long Beach Memorial Hospital how many transfusions.” 11. Hepatic necrosis. in San Diego. I searched the internet, “Iʼve also used hyperbaric oxygen therapy (7 Medline references) got a phone number, called and left a for sickle cell hematuria.” 12. Aerobic septicemia. series of voicemails. After receiving no (2 Medline references) responses to my inquiries, I called again. David Freels: “Hematuria?” 13. Nonvascular causes of chronic brain Still no reply. I called thirteen more times. syndrome (Pickʼs disease, Alzheimerʼs Finally somebody answered and said they Dr. Hart: disease, Korsakoffʼs disease). would give my number to Dr. Hart. I Blood in the urine. Again, 2 atmospheres (6 Medline references) waited. Two weeks, maybe three. I called hyperbaric oxygen twice a day in a 14. Tetanus. (36 Medline references) back. A secretary answered and said she monoplace chamber. Resolved in 3 days. “ 15. Systemic aerobic infection. remembered my 15 previous calls. She said “Whatʼs your interest in sickle cell (39 Medline references) she had given my message to Dr. Hart, but anemia? 16. Organ transplantation. he was retired. I scoured the Internet and Are you a physician?” (192 Medline references) came across his home number and I left him 17. Organ storage. (13 Medline references) a message. No responses, so I called back. David Freels: 18. Pulmonary emphysema. I called again later that day and Mrs. Hart “Uh, no sir. This might sound kind of (18 Medline references) answered and she got him on the phone. confusing. I donʼt know if you know this, but 19. Exceptional blood loss anemia. Hyperbaric Oxygen Therapy is governed by (82 Medline references) He said heʼd take the call “downstairs, in my the Health Care Financing Administration- 20. Multiple Sclerosis. ofﬁce.” He sounded nice. Gentle. Patient. -you know, HCFA. See, HCFA has this (96 Medline references) Kind. The warmth in his voice surrounded list of what they call ʻcovered indicationsʼ 21. Arthritic Diseases. like an authority built on a lifetime of for hyperbaric oxygen. For some strange (38 Medline references) experience. He had done work on sickle cell reason they have a second list too. Itʼs titled 22. Acute cerebral edema. and hyperbaric oxygen therapy. In 1991 the ʻNoncovered Conditionsʼ and says, ʻNo (24 Medline references) Journal of Hyperbaric Medicine published program payment may be made for HBO in his “Amelioration of Sickle Cell Crisis the treatment of the following conditionsʼ. When I ﬁrst reviewed the “Noncovered With Intensive Hyperbaric Oxygen.” Number 8 on the “Noncovered” list is Conditions” list in July, 2000, the eighth ʻsickle cell anemiaʼ.” one down caught my eye. Sickle cell Paragraph 5 of the Medicaid law says anemia. People of color, people of African kids must have whatever is “necessary to descent get sickle cell. I live in Dekalb correct or ameliorate” and the ﬁrst word Dr. Hart: County, Georgia--which is predominantly in Dr. Hartʼs paper was Amelioration. This “Thatʼs true, but whatʼs your interest in African-American. In the summer of was perfect. sickle cell anemia?” Hyperbaric Medicine Today - 9 Featured Article Dr. Hart: “Iʼm doing this.” Dr. Hart: “How do you know that?” David Freels: “Iʼm not so much interested in sickle cell David Freels: David Freels: as Iʼm interested in the “Noncovered” list. “Are you seeing some good results?” “We talk. Itʼs taken me awhile to track Iʼm actually more interested in number you down. Youʼre a hard man to get a hold 10, ʻacute or chronic cerebral vascular Dr. Hart: “I canʼt say.” of. Dr. Harch knows a lot of people, and insufﬁciencyʼ. You see my wife and I are I ﬁgured he might know you, so I asked the parents of a brain-injured child. Heʼs David Freels: him.” had 42 treatments of hyperbaric oxygen, “How many treatments have you done?” and weʼd like to get him some more.” (see Dr. Hart: “How do you know Harch?” Volume I, Issue VI, p.33) Dr. Hart: There was a pause. “Weʼre about half way through.” David Freels: “Dr. Harch spoke as an expert witness at Dr. Hart: David Freels: our ﬁrst Medicaid hearing date a few weeks “How did your son do with the HBO?” “No kidding. Thatʼs great. Youʼre seeing ago.” some good stuff then, huh?” David Freels: “He did great.” Dr. Hart: “Medicaid?” Dr. Hart: “I canʼt say.” Dr. Hart: “Like what?” David Freels: David Freels: “Jimmy is a Medicaid recipient because David Freels: “Thatʼs okay. I know you are.” of his, uh, situation, and according to “Much better speech. Greatly improved the federal Medicaid law for children, ﬁne motor skills. On Fatherʼs Day he said, Dr. Hart: “How do you know that?” Georgia Medicaid should be paying for ʻLook Dad,ʼ and stabbed a bean with his more hyperbaric oxygen. Theyʼve denied fork and then put it in his mouth. He can David Freels: us because they go by Medicareʼs HBO now feed himself for the ﬁrst time. He “Itʼs something like over 90% of every policy.” used to speak in two-word couplets. Now kid who gets HBO has some kind of he talks in sentences. Paragraphs even. He improvement. Some say itʼs closer to Dr. Hart: initiates conversation.” 95%.” “Are they saying itʼs experimental and investigational?” Dr. Hart: “Hmm. What was your Dr. Hart: “Who says that?” protocol?” David Freels: David Freels: “Dr. Harch. Paul Harch.” “And not medically necessary, and not the David Freels: standard of medical practice .” “One hour at one point seven ﬁve Dr. Hart: “You know Dr. Harch?” atmospheres, once a day, ﬁve days a week. Dr. Hart: “Theyʼre right.” He had 42 treatments. We did SPECT scans David Freels: too.” “Heʼs great. I think he ought to get the David Freels: Nobel Prize.” “Yeah, but thatʼs not what the Medicaid Dr. Hart: “What did the SPECT show?” law says.” Dr. Hart: David Freels: “Harch isnʼt going to get credit for this.” Dr. Hart: “Whatʼs it say?” “His cerebral blood ﬂow improved 25.4%.” David Freels: David Freels: “I thought you said it wasnʼt working?” “It says, here Iʼll read it to you. These kids Dr. Hart: are supposed to get ʻsuch other necessary “Weʼre doing a double-blind controlled Dr. Hart: health care, diagnostic services, treatment, study of hyperbaric oxygen on cerebral “I didnʼt say that. I just said I couldnʼt and other measures to correct or ameliorate palsy.” say.” defects and physical and mental illnesses and conditions discovered by the screening David Freels: David Freels: services, whether or not such services are “Really? I thought you were retired.” “You just did. You know Dr. Harch is a big covered under the State plan.ʼ” There was a slight pause. admirer of yours.” Dr. Hart: “So?” Hyperbaric Medicine Today - 10 Featured Article “Really. I used to be president of the “Who was this who gave you the order?” David Freels: UHMS.” “It doesnʼt say ʻmedically necessaryʼ; it Dr. Hart: says “whatever is...necessary to correct or David Freels: “I canʼt say, but youʼd recognize the name ameliorate.” “Where did the second list come from, the if I told you. Listen, Iʼve treated so many “Noncovered” list?” retired Navy ofﬁcers whoʼve stroked. Iʼve Dr. Hart: put them in the chamber and theyʼve made “Hmmm. So whatʼs sickle cell got to do Dr. Hart: “It came from me.” a complete recovery.” with this?” David Freels: “Youʼre kidding. Why?” David Freels: David Freels: “So Hyperbaric Oxygen Therapy works for “The hearing reconvenes the latter part of Dr. Hart: stroke?” September 2000, and Iʼm trying to get ready “I told Social Security that I didnʼt want for it. See, I live in Atlanta, and thereʼs to be on the committee, but they kept Dr. Hart: probably a 65% black population here. My asking. So ﬁnally I said yes. Under one “Of course it works. It works for stroke congress-person is a lady named Cynthia condition.” better than just about anything else, except McKinney, whoʼs very good at bringing in maybe DCS.” national and international media attention David Freels: “What?” to any situation or circumstance where she David Freels: “DCS?” feels black people are exploited; particularly Dr. Hart: by the government. I think she does lunch “They let me add the “Noncovered” list.” Dr. Hart: with Louis Farrakhan. Iʼd like to bring this “Decompression sickness. The bends. It sickle cell and hyperbaric oxygen thing to David Freels: “Why?” hits scuba divers. Listen, if they made HBO her attention, that way some other Georgia available for everything it works for, three- Medicaid kids can get some off label HBO Dr. Hart: fourths of the nursing homes in this country from the “Noncovered” list and we can use “Because one day this guy came to my would shut down inside of six months. that in our hearing. You know, whatʼs good ofﬁce. He was a very, very, very senior Everybody would go home. They wouldnʼt for the goose is good for the gander.” government ofﬁcial, whose name you need them. It works for stroke, MS, would recognize. He came into my ofﬁce Parkinsonʼs, Alzheimerʼs--Alzheimerʼs, let Dr. Hart: and pointed his ﬁnger at me and said, ʻYou me tell you. See, thereʼs a very real, very “Thatʼs not a bad idea. Do you know where will not, under any circumstance, approve serious disease where the vascular tissue the “Noncovered” list came from?” Hyperbaric Oxygen Therapy for stroke.ʼ” breaks down in the brain with age. Creates “Why not, I said. It works.” dementia, senility. What everybody now David Freels: “ʻI donʼt care,ʼ he said, ʻIʼm not going to let calls Alzheimerʼs.” “I donʼt know. The UHMS I guess.” you do it.ʼ” “But it works, I said. You know it works.” David Freels: Dr. Hart: “ʻI donʼt care, he said, itʼll break the bank, “Hyperbaric Oxygen Therapy works for “Sort of. It came from a committee the and Iʼm not going to let you do it. Youʼre Alzheimerʼs?” Social Security Administration put together not going to approve this for stroke, and back in the early 1970ʼs when they were thatʼs an order.ʼ” Dr. Hart: deciding what hyperbaric oxygen would be “An order?” I asked.” “Of course it does. You just canʼt wait until used for.” “I was an ofﬁcer in the United States Navy. theyʼre blithering idiots before you give it Iʼm retired now. I was given an order, and I to them. Youʼve got to give it to them early David Freels: had to obey it.” enough in the disease process. If you wait “Really. How do you know that?” until their brains are mush itʼs not going to David Freels: do them any good at all.” Dr. Hart: “What did he mean by ʻbreak the bankʼ?” “I was chairman of the committee.” David Freels: Dr. Hart: “Do you realize what youʼre telling “He thought the country would go bankrupt me? Youʼre telling me there really was David Freels: if we treated everybody who had a stroke. somebody on the grassy knoll in Dallas.” “Wow. Are you serious? Really?” At that time there were probably less than a hundred chambers in the whole country. Maybe just 30 or 40.” Dr. Hart: Dr. Hart: David Freels: “Listen, I spent my entire career working Hyperbaric Medicine Today - 11 Featured Article for the government. Anybody who works Dr. Hart: “Exactly.” David Freels: for the government as long as I did can “That was 30 years ago. What if you spoke tell you stories like this. I donʼt care what David Freels: Congressional hearing, where your identity department or agency they work for. “But the “Noncovered” list is just an off was hidden and you were given some sort Everybody could tell you something like label list?” of, I donʼt know, protection. Immunity from what Iʼve just told you.” whatever. I donʼt remember what they call Dr. Hart: “True.” it. Whatever Oliver North was given.” David Freels: “Can you give me an afﬁdavit. You know, David Freels: Dr. Hart: put into writing what you just told me. “And 75% of all medications are prescribed “Iʼll say something at the right time in the Weʼve got this hearing coming up, and I off-label--” right place, but not until then.” know what you just told me would be very helpful.” Dr. Hart: “True.” David Freels: “Dr. Hart, I just called today to ask you Dr. Hart: David Freels: about your sickle cell research. Never in “No I wonʼt do that, and if anybody asks “In pediatric neurology, itʼs right at 100% a million years did I ever expect this. But me about what Iʼve just told you, Iʼll deny of everything prescribed for brain-injured look, Iʼve got a brain-injured kid. What every bit of it.” children is prescribed off-label.” youʼve just told me, if I could bring back into our hearing what youʼve just told David Freels: “Why?” Dr. Hart: “Doesnʼt surprise me.” me, weʼd win, hands down. Especially if youʼve got the documentation to back up Dr. Hart: David Freels: everything youʼve said, and I presume you “Look, I was given an order. If I violated “Maybe you donʼt realize this, but when do. Every brain-injured kid in the country that order I would have been guilty of people see something on the “Noncovered” would win. Every kid around the world, insubordination. I wasnʼt going to do list, you know, the people in the hospitals not to mention stroke, MS, & Alzheimerʼs. that. Instead, I agreed to serve on Social where most of the chambers are, and What youʼve just told me should be on Securityʼs Hyperbaric Oxygen Committee they see that list coming from the federal the cover of Time Magazine, Newsweek, only if they would let me put out the two government, theyʼre not seeing that list CBS, NBC, CNN, you name it. But if I lists: The covered list and the “Noncovered as being off-label, they see it as illegal to told anybody about this it would sound like indications.” provide hyperbaric oxygen for any disease something from the National Enquirer. You on the “Noncovered” list. They literally need to tell this story to somebody besides David Freels: think they would be breaking a federal law me.” “But what good does that do?” if they gave hyperbaric oxygen therapy to somebody whoʼs had a stroke.” There was Dr. Hart: Dr. Hart: silence on the other end of the line. “I will. When the time is right.” “They were going to approve it for what they “Dr. Hart?” David Freels: were going to approve it for whether I was “So, can you still send me some stuff on on the committee or not. When they kept Dr. Hart: sickle cell?” asking me to chair the committee, I insisted “You may be right, but I canʼt help that. on the second list because I wanted people Look Iʼve made it my lifeʼs work to prove Dr. Hart: “Sure.” to question why it wasnʼt approved for Hyperbaric Oxygen Therapy works for as things beyond just the covered indications. many things as I could on the “Noncovered” David Freels: “Well, thank you.” The only way I could guarantee that list. Thatʼs been the primary focus of my questioning would take place was to create research. I donʼt know what else I can do.” Dr. Hart: the second list, to spell it out. Hyperbaric “Remember. Iʼll deny this if anybody asks Oxygen Therapy has such a wide range of David Freels: me.” uses I wanted people to say ʻwhy is it not “Why donʼt you tell somebody what you covered for this when it works for that?” just told me? This is a pretty amazing David Freels: David Freels: “Like sickle cell anemia?” story, but Iʼm nobody. Why donʼt you sit “Well, if I tell anybody, just dontʼt sue down with Mike Wallace on 60 Minutes or me.” Dr. Hart: “Yes.” something.” David Freels: Dr. Hart: “And cerebral vascular insufﬁciency?” “Iʼm not going to do that. I canʼt do that. I had to follow orders.” Hyperbaric Medicine Today - 12
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